New advice to prevent and correct flat head syndrome in babies
November 28th, 2011
07:51 AM ET

New advice to prevent and correct flat head syndrome in babies

Since 1992, when the American Academy of Pediatrics began recommending that babies sleep on their backs, the number of deaths due to Sudden Infant Death Syndrome or SIDS - the number one cause of death among infants younger than 1 year of age - has been cut in half, according to the CDC.

However, as the number of SIDS deaths have gone down, pediatricians have seen a dramatic increase in babies having flat head syndrome. About 13% of healthy infants have some form of positional plagiocephaly (which means "oblique head" in Greek).

"[Babies] spend almost all their time on their back," says pediatrician Dr. James Laughlin, "that leads to some positional flattening or molding of the head, depending on how the baby sleeps." 

The longer they do that during the first 2 to 4 months of life, the more likely they are to develop a flattening of the head, says Laughlin, who is the lead author of a new report designed to provide guidance for pediatricians to help prevent, diagnose and manage positional skull deformities in otherwise healthy children.

Most babies' heads are slightly asymmetrical. Their skulls are soft and made up of movable plates (which are necessary for baby to make it through the birth canal).  In between these plates are spaces, which allow the skull to expand so that the brain can grow. If the baby's head always rests on the same spot, the skull plates move in a way that leaves a flat spot, according to the NIH.

The AAP and NIH caution that even though having your baby sleep on its back can lead to a flattened head, parents should not stop placing babies on their backs to sleep.  Asymmetry of the skull when caused by positional molding doesn't cause developmental delays, says Laughlin. "This is cosmetic."

The new report, published in the journal Pediatrics on Monday, suggests that pediatricians should counsel new parents about how to avoid flat head syndrome when they bring their newborns in for their check-ups in the first 2 to 4 weeks of life.

Until a baby is one year old, doctors should also screen for skull deformities at every wellness visit.

Only if the flattening of the head worsens by the time baby is 6 months old and the infant has serious flat spots should head-molding helmets be considered, according to the new guidelines. "There is currently no evidence that molding helmets work any better than positioning for infants with mild or moderate skull deformity," according to the report.

Surgery should only be considered when all other options have been exhausted, and after consulting with a surgeon who specializes in these types of cases.

There are simple steps parents can take to prevent flat spots, and they can also be used to minimize the progression if a positional skull deformity has already developed:

– Increase "tummy" time, which is supervised time during the day when baby lies on its stomach.  A baby should spend at least 30 to 60 minutes a day on it's belly, something that can be done immediately after birth.  This will help develop neck and shoulder muscles, says Laughlin. It has also been shown to "enhance motor developmental scores," according to this new report.

–  The NIH recommends changing the direction your baby lies in the crib each week.  They say this change will encourage the baby to turn his or her head in different directions to avoid resting in the same position all the time.

– Some babies prefer to hold their head to one side. Laughlin suggests laying them down in a different way when they're awake, so they have something interesting to look at on the opposite side. If you have them in a car seat or sitting in something else, you can also change the position to make the baby look in the opposite direction.

– Parents may find their babies sleep well sitting in a car seat, but this is another way they can develop an asymmetrical shape, especially in the first 6 months of life.  So experts suggest babies shouldn't spend a prolonged period of time in a car seat (unless they are in a car of course) or bouncy seat.

– Cuddle!  The NIH says "getting cuddle time with the baby by holding him or her upright over one shoulder often during the day," is another way to prevent flat spots.

"In the majority of these cases, this will correct itself on its own, without any or only minimal intervention," says Laughlin. "Because more than half of infants will improve by 6 months of age, repositioning should be attempted as initial treatment.  In most cases, flat spots usually go away when a baby starts sitting up on its own.

soundoff (1,678 Responses)
  1. JB

    Wearing your baby in a structured carrier, sling, or wrap also can help prevent this problem. Babies were not meant to be laid in cribs and car seats for most of the day.

    November 28, 2011 at 09:16 | Report abuse | Reply
    • OvernOut

      Amen to that!

      November 29, 2011 at 05:13 | Report abuse |
    • MIMama

      THANK YOU!!! I am also glad the article mentioned cuddling.

      November 29, 2011 at 08:31 | Report abuse |
    • CC

      Babywearing hands down will help prevent this and probably lead to a happier baby too! http://www.babywearinginternational.org/images/BWI%20newsletter%20Nov-Dec%202011.pdf

      December 15, 2011 at 13:32 | Report abuse |
    • Marcus

      We used the ErgoPillow by Lazy Lambert for our boys molded head. It worked great. I would highly recommend it to anyone considering a flat head pillow. I got an organic one with a cute airplane print. My baby loves it too.

      November 4, 2014 at 16:19 | Report abuse |
  2. Cat

    I wish I had known this. One of my twins developed a very noticeable lopsided flat head. He was in daycare and I suspect spent a lot of time in crib, seat, etc. Looking back, I would have given him more "tummy time" and prevented the whole thing. The other twin never had this problem. My son looks totally normal now as a teenager thank goodness. I'll definitely remember "tummy time" with my grandkids!

    November 28, 2011 at 10:19 | Report abuse | Reply
  3. IronCelt

    My spouse has a flat area on the back of his head. He's fifty-five years old and it's never affected him in any way.

    November 28, 2011 at 11:18 | Report abuse | Reply
    • Tainara

      But I don't hold them in the in box. Using SpeedFiler (pbuh) I file as normal once haivng read and flagged them. I then work my way through the Follow Up' in Outlook as and when I (a) have time and (b) need to. Thus the emails are always there in the right folders with the relevant other emails etc and when I've dealt with it I simply Clear Flag' and the email is already filed with the reply I sent etc.

      August 4, 2012 at 02:16 | Report abuse |
  4. Va

    This is very rare but worth considering if – like the article said – there is still a problem as the child is not spending so much time on their back. My son had flattening in the back of his head when babies were still put on their tummies to sleep. He also had some motor developmental delays. He was diagnosed with Craniosynostosis of the Lambdoid suture that runs along the back of his head. Surgery was done and he recovered and is doing well in life as an adult.

    November 28, 2011 at 12:35 | Report abuse | Reply
  5. Blacksheep

    That is not correct. Plagiocephaly can cause developmental delays, or is at least associated with it. One of my twins has it and is still suffering the consequences!

    November 28, 2011 at 12:35 | Report abuse | Reply
    • toddflanders

      YOu are completely wrong. Plagiocephaly will not cause developmental delays. Perhaps a twin birth would be a more likely reason for delays.

      November 29, 2011 at 21:26 | Report abuse |
    • Phil

      Here's a study that finds that it IS associated with brain damage. http://www.ncbi.nlm.nih.gov/pubmed/16404269

      February 27, 2013 at 21:21 | Report abuse |
    • VBLitteone

      Phil. Your article refers to "deformational plagiocephaly", but most kids have "positional plagiocephaly", which comes from car seat usage, cribs etc. The later is harmless, you can refer the same site. There are articles on the site indicates later is harmless, and the former is what is of concern.

      July 22, 2013 at 01:32 | Report abuse |
  6. Va

    I am sorry about your little one. In my son's case it was only the back suture line that was prematurely fused and surgery was done early enough to correct the problem before there were permanent problems. He is a college graduate with an above average IQ.

    November 28, 2011 at 13:07 | Report abuse | Reply
  7. AliP

    Maybe it's not so bad to have a baby sleep on their stomach – SIDS might be related instead to fire retardant chemicals in crib mattresses:

    A 100% successful crib death prevention campaign has been going on in New Zealand for the past 11 years. Midwives and other healthcare professionals throughout New Zealand have been actively advising parents to wrap mattresses. During this time, there has not been a single SIDS death reported among the over 100,000 New Zealand babies who have slept on mattresses wrapped in a specially formulated polyethylene cover. The number of crib deaths in New Zealand that have occurred since mattress-wrapping began in 1994 is about 810. The number of crib deaths that have occurred in New Zealand on a properly wrapped mattress is zero.


    November 28, 2011 at 13:29 | Report abuse | Reply
    • MIMama

      Thank you for this. Breastfeeding and sleeping near your baby (safely in the bed or baby's sleep area sidecarred to the bed) also have been shown to dramatically reduce SIDS.

      November 29, 2011 at 08:33 | Report abuse |
    • ttroth

      I have babesafe wrapped my baby's mattress and playyard matress. I believe this theorey has a lot of merit.

      March 27, 2012 at 01:32 | Report abuse |
  8. JCBMD

    Positional plagiocephaly is absolutely harmless, but the "experts" who make these types of recommendations often miss common sense solutions. Placing the crib against the wall, and rotating the end where the baby's head is placed every 2-3 weeks makes the infant look toward different sides, preventing a flat spot on one side (babies look away from walls and toward the door anticipating the parent). Also don't place a mobile over the end of the crib where the babies head is placed. Put one over the foot of the crib so that the baby has to turn to the side to see it. Using normal child behavior can really help. Children love to look for their parents, and are curious about their environment. Keep this in mind, and keep them looking all around, and the head will stay round. Above all, don't put anything in the crib to keep a baby on his back, this increases both positional plagiocephaly and the risk of crib death.

    November 28, 2011 at 13:34 | Report abuse | Reply
  9. mcconkey

    my baby girl is currently wearing a helmet to correct her flat spot. i love the helmet & dont look forward to the day she dont need to wear it anymore. it protects her from all the falls & slips she has being as we have all hard wood floors. just saying.

    November 28, 2011 at 13:52 | Report abuse | Reply
    • Honey Bhardwaj

      My kid, 10 months old is with flat spot on right side of head and because of that his left side is out too. Please suggest me what to do? What does this helmet you mentioned will do? Please help with solution

      April 16, 2019 at 12:27 | Report abuse |
  10. Lily

    I think New Zealand study is facinating and makes most sense of all. Thank you AliP for the information.
    And, yes, babies should be held in arms and/or baby carriers more than seems to be the norm in this country.

    November 28, 2011 at 13:53 | Report abuse | Reply
  11. JHosley

    After 52 years in healthcare, most of it in maternal and child health, I have seen the theories for SIDS come and go. I suspect much of the decline in reported SIDS death is that we now have better diagnostic measures to determine why a baby died, rather than lumping all infant deaths under SIDS. Remember the theory that one SIDS death in a family was an accident but two had to be murder? That theory was accepted without question about 20-25 years ago; now we know that there is a familial susceptibility. I suspect the current theory of prone sleeping v/s back sleeping will turn out not to be the reason for declining SIDS deaths as all of the other theories to this point have petered out, but we will have generations of flat-headed babies for no good reason. I spent most of half a century tending babies and I rejoice that the deaths are declining, but I do not think it will prove to be the result of position; rather, I think it will be separating the causes of death by actual pathology. Unfortunately, a lot of money and a lot of professional credibility has gone into pressing this one cause and one cure.

    November 28, 2011 at 14:28 | Report abuse | Reply
  12. Virginia

    My youngest son was born wanting to see the world. He pushed away from my shoulder as we wheeled out of the hospital and looked around. Don't know what he could see that early but he wanted to see it. After a few (and I literally mean a few) weeks, I saw the baby asleep on his stomach and was panic stricken. Then I noticed. I flip him on his back he flips back over on his tummy and lifts his head. He is 8 now and is still in a hurry to see everything.

    November 28, 2011 at 15:13 | Report abuse | Reply
    • Mom

      My mom reported that my brother rolled over before leaving the hospital (according the the nurses), my youngest within the first week could roll over, and my older son within 10 days could roll either direction. You can't make a baby who can roll on his own sleep on his back!

      November 28, 2011 at 16:40 | Report abuse |
  13. angelaD

    Growing up in Germany I remember the "ceremony" of having to rotate babies in the crib. Young mothers were made aware of this just like learning how to feed and dress them. Having a nice round head was/is somehow important....
    My kids now have perfectly round shaped heads 🙂

    November 28, 2011 at 17:21 | Report abuse | Reply
  14. Poodles

    Stop hitting your kids with frying pans! This will help not having flat spots.

    November 28, 2011 at 18:08 | Report abuse | Reply
    • 2 to 4

      Good one, Poodles! You had me laughing out loud at that one!

      November 30, 2011 at 04:15 | Report abuse |
  15. Cat

    My son was another early "roller". He didn't make it all the way onto his tummy for a while, but he would roll onto his side at about a week old. After a while of turning him back onto his back while in the crib, I decided that if he was strong enough to keep rolling onto his side then there was nothing I could do to prevent it. A few days after that I would come in to find him on his belly with his knees under him – tush up in the air. He has had a wonderfully-shaped head from birth (being a breach baby).

    November 28, 2011 at 21:29 | Report abuse | Reply

    There are lots of parents that have their newborns in their newborn buckets for 12+ hours per day then transition them to their crib ... that has to be a huge contributor to flat head syndrome. Take the kid out, hold them as much as you can, get a sling or baby bjorn, and put them on their tummy when they are playing on the floor and you simply won't have this problem.

    November 28, 2011 at 23:04 | Report abuse | Reply
  17. Kabra

    Carry your baby! It's actually good for other areas of their development too. Babies don't learn anything just laying on their backs staring at whatever is right over them.

    November 28, 2011 at 23:47 | Report abuse | Reply
  18. OvernOut

    My kids, now all in college, have very handsome heads, and for the most part, the stuff inside is working OK, too. My son's hair all migrated to his chin by age 21, he is ok with that because his head has a very nice shape. Get your kids out of the car seats, no flat heads. We were lucky too because our kids were little light-weight babies, got passed around a lot and held all the time. Very few photos of them in car seats, they are usually pictured in someone's arms or on someone's hip. Sure, babies want to look at you, but they also want to look at what you're looking at, and they can only do that if they are being held.

    November 29, 2011 at 05:29 | Report abuse | Reply
  19. Cortez

    As a person that grew up in a latino community, I noticed this more amongst my people more than any other.

    November 29, 2011 at 05:50 | Report abuse | Reply
  20. Jennifer

    To all those who mentioned carrying your babies, I say AMEN! My ring sling and Ergo carrier have been lifesavers. I figure, if you just want to leave your baby laying in his/her crib all the time so you can do other things, why did you bother to have a kid? It's easy to get things done while you are still able to carry the baby around... when he/she gets older and wants to be running constantly, you sure aren't going to get things done then! Enjoy the quiet time holding and snuggling your baby while you can, they grow up too fast and don't want to be held anymore!

    November 29, 2011 at 09:42 | Report abuse | Reply
  21. Rodeoguy

    Because I listened to my doctor my kid has a lopsided head. I am going to print this artical and give it to my lawyer.

    November 29, 2011 at 15:50 | Report abuse | Reply
  22. Jaded

    My 15 year old daughter had a flat head when she was a baby and now she has ADD and is gay. Obviously cause and effect. I should sue the makers of her crib, car seat, and bouncy chair.

    November 29, 2011 at 21:20 | Report abuse | Reply
  23. Tracie

    Stupid yuppie parents. Kids have been born for thousands of years. Most of us drank whole milk before a year, slept on our stomachs and in our OWN beds for that matter and have turned out just fine. These articles were so stupid...children haven't changed, it's the morons who buy into this crap who reproduce them. I seriously think you should have to have a license to have a child...

    November 30, 2011 at 04:01 | Report abuse | Reply
    • 2 to 4

      And if a license were required, one of the requirements would be to always put your baby on it's back when sleeping. DOCTORS would be writing the requirements, who else do you think would be writing them?

      November 30, 2011 at 04:19 | Report abuse |
  24. Tracie

    Of course they would...any way to make money with stupid claims...

    November 30, 2011 at 04:46 | Report abuse | Reply
  25. Jim

    Research is suggesting there is a link to developmental delays, and its only now that data is emerging since this policy only 20 years old. A pediatrician is not a scientist, nor is qualified to make blanket statements like "this is cosmetic only". They service babies and subtle delays or impacts would not be something they could notice because of the wide range we call "normal".

    December 2, 2011 at 07:27 | Report abuse | Reply
  26. Gina

    I used the Shapeguard Pillow made by Tots 2 Be and it worked great! Within the first weeks of use I saw improvement on the shape of my baby's head. This pillow comes attached to a vest or wearable blanket so it stays in place and it won't cover the baby's face. I wish I had known about this great product for flat head syndrome even sooner! Their website is tots2be.com if you wish to take a look.

    February 24, 2012 at 13:20 | Report abuse | Reply
  27. ashley

    This is a great product invented by a neurosurgeon for preventing flat head syndrome before it starts. i know people who have used this and their babies have perfect little round heads! http://www.myangelsguardian.com/index.html

    March 29, 2012 at 15:09 | Report abuse | Reply
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  42. nat

    I'm so glad I read this article. I just recently noticed a flat spot on my daughters skull and was concerned so I looked around on the interner reading all kinds of articles. It turns out my daughters spot was developing due to having torticollis, she is 12 weeks. I have been working with her doing neck exercises and tummy time, she can turn her head to the right now which she could not so before. I have 2 other tots and no one have ever emphasized how important it is to rotate your baby while they sleep. Hopefully her flat spot will improve and this article has made me feel hopeful.

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